Good communication is first line of defense

A patient with a badly fractured leg that was not healing well could be crippled for life. She went to see her orthopedic surgeon to see what could be done next. The surgeon said, "Well, let’s see if we can put Humpty Dumpty back together again," and then he chuckled.

The patient already was angry that the doctor’s first efforts did not work well, and this comment made her believe that he was not taking her concerns seriously, says Joel Cronin, JD, MD, managing partner, Romano, Eriksen, and Cronin, a West Palm Beach, FL, law firm. The patient sued, Cronin says. Watch what you say to patients and their families, he recommends. While a humorous remark may make you feel relaxed, an anxious patient may believe you aren’t taking the procedure seriously, he explains.

Don’t just talk; listen

If you communicate clearly with your patient, you can reduce your risk of a malpractice suit, says Bill Duffy, RN, MJ, CNOR, assistant vice president of perioperative services for Evanston (IL) Northwest Health Care. "You must also remember that communication is not just talking, but it is listening as well," he adds.

While every same-day surgery manager is looking for ways to improve efficiency, "You must balance your quest for efficiency with concern for the patient," Duffy points out. Be sure to take a few extra minutes to make sure the patient and family members understand what you are saying, he suggests.

Also build in a process to study patient complaints, recommends Duffy. This process can be a formal patient survey or a less formal method of collecting patient comments made to staff members and physicians, he says. "Study the complaints for trends. If you see several patients complaining of poor discharge instructions, look at how you present instructions and evaluate methods to improve the communication," he says.

Be careful to not discount a low number of complaints, warns Duffy. "You may only have five patients that complain, but the sixth patient to encounter the same difficulty might sue," he says. You need to have some method of identifying potential problems, he adds.

Keep family members updated

Don’t forget to communicate with the family members also, Cronin advises. The reputation of a same-day surgery program’s caring staff grows as much from comments by family members as comments by patients, he adds. "If a family member is waiting and has been told the surgery will last 30 minutes, that person expects someone in the waiting room 35 minutes later," he says. If the family has to wait much longer, they begin to imagine that something bad is happening, he says.

"A staff person can go to the waiting room, explain that everything is fine and the procedure was late starting and it will be a little longer," he suggests. This reassures the family member that he or she has not been forgotten and that the patient is fine.

Same-day surgery staff members need to remember that what is an ordinary part of the day to them is a real concern to the patient, says Cronin. The more that can be done to reassure patients and family members that staff members understand this point, the less likely the patient will sue, he adds.

One other important way to show patients and family members that you are concerned about their welfare is to be available, says Cronin. "An administrative person, who will not be defensive, must be on site and ready to listen to any complaint or concern a family member or patient wants to express," he says.

Managers should listen and thank the person for bringing it to their attention because they always want to know how service can be improved, he adds.